MDR can develop when patients get the wrong drugs, drug supply is unreliable or patients stop taking their medicines because they feel better.

Tuberculosis and Children

Worldwide, over 100,000 children will die from TB this year.

Hundreds of thousands of children will become TB orphans this year.

MDR TB in poor countries can be a death sentence.

Tuberculosis and Women

Worldwide, TB is the single biggest killer of young women.

Over one million women will die needlessly from TB this year.

Tuberculosis and HIV

TB accounts for one third of AIDS deaths.

If a person is HIV positive, that person is 30 times more likely to get sick with TB once infected.

Blood Culture for Diagnosing TB in HIV Infection

Delayed recognition of tuberculosis (TB) allows progression, and continues to transmission to others of a potentially fatal infection. The hospital setting often brings together in close proximity persons with tuberculosis and those highly susceptible to it.

This prospective study recruited consecutive febrile patients 18 years or older at the time of admission to an infectious disease hospital in Thailand or to a general hospital in Malawi in 1997. Of the 344 enrolled, all of whom had blood taken for mycobacterial culture (Isolator tube) and HIV testing, 10% (34) had Mycobacterium Tuberculosis Bacteremia. Among the 74% (255) who were HIV positive, 13% had M.Tuberculosis bacteremia. TB was unrecognized at the time of admission in 30% of patients in the infectious disease hospital and 71% in the general hospital. Clinical findings that predicted positive blood cultures for M. tuberculosis among febrile HIV-positive patients included oral thrush, chronic fever, cough, or weigh loss. Three patients with positive blood cultures who reported cough had normal chest x-ray, but their sputum was not examined for AFB. Among the 20 M. tuberculosis isolates obtained from Thai patients, 25% showed multidrug resistance.

Comments

TB manifests in protean ways and often goes unrecognized. A person with HIV infection can have viable mycobactria in sputum despite a negative X-ray. The study shows that mycobacteremia is common and that blood culture provides a relatively easy and high-yield way to diagnose TB in HIV positive patients in developing countries where rates of TB are high.

Jails and Tuberculosis

As tuberculosis (TB) transmission declines in the US, this disease is likely to become concentrated among core transmission groups. Elimination of TB will require identification and targeting of these remaining reservoirs of infection. This report outlines patterns of TB transmission in a jail in Memphis, TN.

From January 1995 through December 1997, 34 active cases of TB had this RFLP pattern. Researchers cross-matched TB and jail registries and discovered that 43% of TB cases in the community had been incarcerated in this jail at some time before their diagnosis.

Comments

House people awaiting trial and inmates serving sentences of less than 1 year. Thus, unlike prisons, where inmates are kept for long-term detention, jails have rapid turnover of residents, making them ideal locations for the transmission of infectious diseases. This report indicates that transmission of TB in jail is common and that TB may spread to people in the community. Jails need to institute intensive programs to identify and treat inmates with active TB. In addition, jails are an important location for targeted testing and treatment of latent TB.